Surgery Consent Form

Please confirm the procedure discussed with your veterinarian.
I, the undersigned, do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal described above, that I do hereby give Animal Hospital of Lake Villa, its agents, and/or representatives, full and complete authority to perform the surgical/medical procedure discussed. I further consent to the performance of operations and procedures in addition to or different from those now contemplated, arising from presently unforeseen conditions, which the above-named veterinarian or his associates or assistants may consider necessary or advisable in the course of the operation. I further consent to the administration of such anesthetics as may be considered necessary or advisable by the veterinarian responsible for this service. To minimize the risk of such occurrences, we offer the following: Pre-surgical exam, Bloodwork, and monitoring the entire time they are here. As my signature below indicates, I understand the nature and purpose of the operation, possible alternative methods of treatment, the risks involved, and the possibility of complications, and I have no further questions. I recognize that the practice of medicine and surgery is not an exact science and acknowledge that no guarantees or assurances have been given to me as to the result of any treatment, medication or procedure given at the hospital.
Like you, our greatest concern is the well-being of your pet. Before putting your pet under anesthesia, we will perform a full physical examination. However, many conditions, including disorders of the liver, kidneys or blood, are not detected unless blood testing is performed. Such tests are especially important before any kind of surgery. For these reasons, we highly recommend blood screening before such procedures. The estimated cost of these important tests is: For pets under 1 year $65, for pets 1-6 years of age $75, for pets 7 years of age and older $115. Please note that the pre-anesthetic bloodwork is required on patients over the age of 7 if not recently done within the last 2 months. For that reason, even if you checked NO, the bloodwork and its cost will still be added if your pet does not fit those requirements.
We recommend placing a microchip while your pet is under anesthesia as the procedure may be uncomfortable.
Laser therapy is a cold light laser that helps to expedite the tissue healing, post-op. Used in the event of tooth extraction.
If your pet's procedure also includes a mass removal, please check one of the above boxes.
We will monitor your pet while they are here to make sure they don't chew blankets or towels.
Has your pet had any medications this morning? If so, please specify in the area below.
The undersigned also understands that all services are to be paid in total when the pet(s) is/are discharged unless prior arrangements are made. The owner or agent promises to pay such total, together with any other charges, finance and/or collection, due thereon. A written estimate will be furnished upon request. Forms of payment accepted include Cash, Mastercard, Visa, American Express, Discover, Scratchpay, or Care Credit. Personal checks are not accepted as a form of payment.

Animal Hospital of Lake Villa
101 S. Milwaukee Ave.
Lake Villa, IL 60046

Phone: (847) 356-8387
Text: (847) 356-8387
Fax: (847) 558-2606

Premier Veterinary Group
Emergency: (847) 548-5300

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